Turning Point – Annual Review 2018-2019

Registered Company Number: 793558. Registered Charity Number: 234887. Registered Provider Code: H2509.

ANNUAL

REVIEW

2018/ 2019

TURNING POINT ANNUAL REVIEW 2018/2019

CHARITY INFORMATION

NON-EXECUTIVE DIRECTORS ■ ■ ■ ■ ■ ■ ■

Sarah Wood OBE (Chair) (resigned 12 September 2018) Peter Hay (Chair) (appointed 11 September 2018) Paul Picknett (Vice Chair) Caroline Bailey (resigned 30 June 2018) Christopher Parker Dr. Alison Hill Nicola Gilham (appointed 08 May 2018)

EXECUTIVE DIRECTORS

REGISTERED COMPANY NUMBER 793558 REGISTERED CHARITY NUMBER 234887 REGISTERED PROVIDER CODE H2509

■ Lord Victor Adebowale CBE (Chief Executive) ■ Julie Bass ■ Helen Spice

AUDITORS Crowe U.K. LLP 3rd Floor The Lexicon Mount Street Manchester M2 5NT

All of the above are key management personnel of Turning Point Group and the Charity SECRETARY Lord Victor Adebowale CBE (resigned from Secretary role 14 May 2019)

BANKERS Barclays Bank PLC Level 11 20 Chapel Street Liverpool L3 9AG

REGISTERED OFFICE Standon House 21 Mansell Street London E1 8AA

SOLICITORS Eversheds Sutherland (International) LLP Eversheds House 70 Great Bridgewater Street Manchester M1 5ES

Turning Point Limited is a private company limited by guarantee without share capital, incorporated in England on 27 February 1964.

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CONTENTS

P4

P14

P22

P28

01 02 03 04 ABOUT US

P34

A SHARED APPROACH TO SUPPORT

OUR PEOPLE

P40

P46

INTEGRATED APPROACHES

P50

05 06 07 08 POPULATION HEALTH AND PREVENTION

P54

HEALTH INEQUALITIES

MENTAL HEALTH

P62

P60

SUBSTANCE MISUSE AND PUBLIC HEALTH

P64

11 07 12 09 10 06 LEARNING DISABILITY

FINANCIAL PERFORMANCE

RESERVES HEALTH INEQUALITIES

03 TURNING POINT ANNUAL REVIEW 2018/2019

CORPORATE OUR STRATEGY PEOPLE

ABOUT US SECTION 01

ABOUT US 04 TURNING POINT ANNUAL REVIEW 2018/2019

ABOUT US SECTION 01

About us Turning Point is a leading social enterprise providing health and social care services for people with complex needs at 350 locations across England. We have been supporting people to make changes in their lives since 1964.

We support people to improve their health and wellbeing whether that be at home, within the workplace or through our specialist services, building on our expertise in substance misuse, mental health, learning disability, autism, acquired brain injury, sexual health, healthy lifestyles and employment.

Over the last seven years we have developed Rightsteps, extending our reach into the employee and wider wellbeing market which continues to grow year on year.

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ABOUT US SECTION 01

OUR YEAR IN NUMBERS 2018/2019 Mental health

27,083

people supported by our mental health services Our talking therapies services supported 17,926 people Our community mental health services supported 1,261 people Our crisis services supported 1,457 people Our helpline in Leicester supported 6,009 people Our specialist and forensic services supported 192 people, and 238 people were in supported accommodation

102,101 people supported

by Turning Point in 2018/19

4,320 people employed

Drugs and alcohol

58,452

people supported by our substance misuse services Our integrated drug and alcohol services supported 57,460 people 629 people went through detox with us 99 people went through rehab 264 people lived in supported accommodation 8,165 people successfully completed treatment There were 119 different main problem substances among clients accessing drug and alcohol services

678 volunteers 06

TURNING POINT ANNUAL REVIEW 2018/2019

ABOUT US SECTION 01

Rightsteps

7,724

people supported through our workplace health and wellbeing programme

Social prescription

720

adults accessed support from a link worker

5,526 views of our Rightsteps Find Out More sessions, providing information and advice

My Turning Point

2,424

people accessed support online 1,495 views of our My Turning Point Find Out More sessions, providing information and advice

Healthy lifestyles Sexual Health

2,287

adults supported by our sexual health services

Young People

1,315

young people accessed our substance misuse and sexual health services

2,636

adults supported to adopt healthier lifestyles

91

children supported to achieve a healthy weight

Quality

Learning Disability

881

people supported

249

supported in residential care, 596 in supported living accommodation and two in independent hospitals.

61 people supported with day opportunities

94%

of Turning Point’s registered services are rated Good or Outstanding

75%

of all independent substance misuse services rated Outstanding in England are delivered by Turning Point

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Employment

1,632

supported by our employment services

ABOUT US SECTION 01

Our Guiding Principles and Values Our vision and values are the heart of Turning Point; they are the essence of who we are, what we do and why we are here.

Social value As a person-centred organisation, our support is tailored and responsive to the needs of individuals we work with.

We believe that everyone, given the right support, can reach their potential. When individuals benefit, so does society as a whole, with positive impacts delivered for the economy and environment, as well as improvements to general health and wellbeing and community cohesion.

Maximising the social value we deliver as an organisation is a key priority for us and as part of achieving this we are committed to:

Our vision is all about extending our reach, positively impacting as many people as possible and truly making a valuable difference. Our values are evident through the work we do with the people we support and we know that they are important to everyone.

Continually looking for new opportunities to support the development of local social enterprises which create new employment opportunities for people who have been excluded from the workforce in the past.

The quality of the support and treatment we deliver means everything to us. The people we work with inspire us and in turn we look for new ways to foster positive change and growth. We owe it to the people we work with to shape the future in a way that improves all our lives.

Employing people with lived experience in all services.

Tackling worklessness through the creation of volunteering opportunities, apprenticeships, bursaries and supporting the people we work with to access education, training and employment opportunities.

We want people to be able to access the support they need when they need it, to prevent issues from escalating and increase access and choice through new and innovative service delivery solutions.

Up-skilling the health and social care workforce.

We are committed to creating the best possible environment for the people we support and our staff, enabling everyone to thrive.

Investing in the local economy where we provide health and social care services, for example by working in partnership with local community and voluntary sector organisations and supporting local suppliers.

Our Values:

Promoting the wellbeing of the people we support and our staff.

We believe that everyone has the potential to grow, learn and make choices.

Promoting social inclusion and community participation for everyone we support.

We are here to embrace change even when it is complex and uncomfortable.

Supporting family and carers.

We all communicate in an authentic and confident way that blends support and challenge.

Supporting people to participate in community life whatever challenges they might face in order to create more cohesive communities.

We commit to building a strong and financially viable Turning Point together.

Minimising our negative impact on the environment.

We treat each other and those who we support as individuals, however difficult and challenging.

We deliver better outcomes by encouraging ideas and new thinking.

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ABOUT US SECTION 01

Support during dark times Alison was supported by an alcohol specialist nurse working for Turning Point as part of an Integrated Personal Commissioning pilot in Croydon.

In 2018/19

629 people went through detox with us

I am a 49 year-old woman with a serious alcohol problem that has spanned my entire adult life.

An unhappy childhood with difficult relationships left me with low self-esteem, little trust of others and a need for acceptance. Alcohol made life easier — at least, in the short term.

At this stage I realised how vulnerable my life was. I was determined not to drink again.

Life wasn’t all bad: I earned a good degree and had success in my profession. But I was stuck in a state of fear and shame about my alcohol use.

My husband was abusive and addicted to drugs.

My key worker supported me and encouraged my attendance at various outpatient appointments, talking through my medical condition and helping me to make positive changes. She also referred me for counselling and this has been so helpful in enabling me to think about my life and recovery.

On my fortieth birthday I left my husband and moved to London. At this point I stopped all drug use, but my alcoholism worsened and I was later diagnosed with liver disease and diabetes.

I have improved radically over the past year and my key worker’s help has been invaluable. Without her expertise, reliability, friendliness and lack of judgement I couldn’t have done it. It saved my life.

I began to seek help but repeatedly relapsed. Having lost my job, I went to Turning Point and attended a pre-detox group. I was able to discuss my situation with others and was assigned a specialist nurse as my key worker because of my complicated medical history and her nursing expertise.

I no longer live with the dread of imminent death and can look forward to a positive future.

At this point, I had been in hospital several times in previous years and was feeling very ill with jaundice, ascites and mobility problems. I was also emotionally unwell and depressed.

In August 2017 I was admitted to Accident and Emergency at King’s College Hospital. My body felt like it was shutting down and my diabetic complications worsened. Following critical medical treatment I detoxed on the ward and my key worker supported me when I was discharged.

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ABOUT US SECTION 01

Statement by the Chair and Chief Executive

This year has seen the launch of a new long term plan for the NHS, and the long-term funding for social care has remained a key focus for policy development.

We are especially proud that 75% of all independent substance misuse services that are rated Outstanding by the Care Quality Commission are delivered by Turning Point.

There is a huge breadth of expertise and specialist knowledge across Turning Point. We employ a wide range of specialists including GPs, psychiatrists, psychologists, therapists and nurses as well as multi-skilled recovery workers and support workers. This is a major asset and demonstrates our vital role in the delivery of public services. As a social enterprise we are able to be flexible and responsive in our delivery, adding social value wherever we possibly can, taking our expertise to new areas of need and challenging how, when and where individuals can access support. Taking evidence based health and wellbeing support direct to the workplace with Rightsteps is a great example of this.

There has been continued pressure on health, public health and social care budgets, which has impacted on public funding and resources available to support those at the margins. The key priorities for the health and social care system – themes which run across these various areas of public policy – include: developing the workforce and strengthening leadership across the system; supporting people to take more responsibility for their own health; improving the support available for people experiencing poor mental health and learning disabilities; improving our approach to prevention with a focus on the wider determinants of health and people’s connections to their communities; and tackling health inequalities. These are also key priorities for Turning Point and provide the themes for our 2018/19 annual report.

We talk about being inspired by possibility. Every day we are inspired by the people who work for Turning Point and the people we support and we would like to take this opportunity to say thank you.

Peter Hay CBE, Chair

We are very proud of our achievements during 2018/19.

Over the course of the year, the organisation has continued to deliver high quality services in a challenging external environment reaching over 100,000 individuals. 94% of our CQC registered learning disability, mental health and substance misuse services are rated Good or Outstanding.

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Lord Victor Adebowale CBE Chief Executive

ABOUT US SECTION 01

From the Group Managing Director

Since its establishment over a year ago, the Operating Board has developed a strong collaborative mode of working.

The Operating Board aims to continue to build on our performance, both financially and operationally, driving health and wellbeing initiatives as well as growth across the organisation and creating social value in everything we do. The board is steering new ways of working and delivering on our digital promise, so that we can provide support for more people than ever before, flexibly and at a time that meets the needs of the individual. We are proud of our innovative and evidence-based approaches including our online behavioural change platform, My Turning Point.

As a board we recognise the value of our senior leaders and that is why we have sought to invest in our leadership, building greater capacity and empowering our senior managers.

Every day we are inspired by the achievements and positive outcomes for individuals we have the privilege of supporting.

We aspire to create a strong, diverse and multi-faceted team across the organisation that is steeped in our core values by creating networks, inquiry groups, leadership events and constantly developing new approaches to learning and development. We have introduced improved ways of communicating with our employees, to encourage greater involvement and feedback and to deliver on our people strategy.

Julie Bass, Group Managing Director

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ABOUT US SECTION 01

People we support In 2018 we launched a new Inspired by Possibility Recognition Scheme to celebrate the amazing progress the people we support have made over the last year. We received over 150 nominations across the range of services and support we provide, with incredible stories of the progress being made.

Drugs and alcohol Duwayne Throughout his journey, Duwayne has demonstrated an unwavering commitment to his on-going recovery. He’s accomplished many goals including passing his driving test, completing college courses, and also taking his first ever holiday abroad earlier this year.

These are all huge steps which he has taken in his stride. Through sheer determination, Duwayne has fought the more difficult periods in his life, which has made him the confident, thoughtful and considerate individual he is today.

Duwayne has been a consistent positive role model, giving hope to others who have been in a similar situation, allowing them to see what can be achieved with hard work and commitment to their own recovery journey.

Following detailed discussions and debate at the panel which included people with lived experience, a final group was selected for a celebration event in Birmingham at the end of January hosted by Turning Point’s Chief Executive Victor Adebowale. The stories shared in the nominations talked about the individual steps each person had made to improve their physical and emotional wellbeing over the last year along with their hopes for the future.

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ABOUT US SECTION 01

Mental health

Learning disability Helen

Katie

Helen now lives in her own flat near her family and has a team around her. She has come on a journey and takes it one day at a time. Recently Helen showed us how remarkable she is. One Friday evening, she was with her support worker in her local town. Her support worker had a seizure and collapsed. Helen swiftly called an ambulance and stayed with her until help came. She called the on-call manager and her family to let them know what happened. When the paramedics arrived she was able to let them know the details of what had happened too.

Giving birth to her son became the catalyst for change for Katie. She has thrown herself into recovery at full speed, making drastic changes to her life. She has rebuilt the relationship with her family, developed a positive and loving relationship with her son and sought support for her mental health. Katie practices yoga and mindfulness on a daily basis, as well as attending mutual aid and peer support groups. Katie is a true example of what it means to be inspired by possibility and demonstrates that change and recovery are possible.

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OUR PEOPLE SECTION 02

OUR PEOPLE 14 TURNING POINT ANNUAL REVIEW 2018/2019

OUR PEOPLE SECTION 02

Our People Our people are our strength and most precious resource.

We strive to mirror the quality of support we provide for people accessing our services with that which we provide to those who work for us.

This means developing leaders who can enable environments and working practices that celebrate and develop our employees, whilst providing support when it’s needed. The health and wellbeing of our workforce is central to our ability to support others.

The quality of our people at Turning Point enables us to deliver strategic priorities and outstanding services. By working together to harness collective skills and supporting each other, we can reach more individuals, communities and deliver even more positive outcomes.

We want our people to feel supported, engaged, positively challenged and that their voices are heard, resulting in confident, caring and resilient people who are championing Turning Point’s vision and values through every interaction. Together we can continue to strive for positive outcomes, improved lives and outstanding regulatory performance as a marketleading organisation.

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OUR PEOPLE SECTION 02

Our People Goals Attracting and retaining flexible, cost effective, high performing people, who bring a diversity of experience and background and who are clear on their responsibilities whilst being driven by our values.

Inspired by Possibility Staff Awards 2018 Our annual Inspired by Possibility Awards put the spotlight on members of the Turning Point team who live our social values and inspire possibility in themselves and others though their actions.

Last year’s 23 winners were presented with certificates and gift vouchers at a celebratory lunch in June 2018.

The winners were chosen from 242 peer-based nominations from across Turning Point’s learning disabilities, mental health, public health and substance misuse and central support services.

Inspiring leadership that champions, promotes and supports the transformation that leads to ever improving outcomes for those that we support and employ.

It’s really important to us to recognise and say thank you to our exceptional people who live and breathe our values. The awards are in the fourth year and the quality of the nominees presented a really positive challenge for the judges.

Building a continuous learning environment where personal leadership will be embraced in line with our values, and mistakes and failures are seen as opportunities to grow and develop.

Striving to be an agile, fast-paced organisation with innovation at its core and a reputation for managing positive change.

Creating a workplace that supports the healthiest version of you in which we all search for ways to encourage others to take whatever steps they can towards greater wellbeing.

Becoming the employer of choice in which involvement and inclusion will drive loyalty and ambition and empowerment will drive our continued success.

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OUR PEOPLE SECTION 02

Temi

Temi is a Recovery Worker at Beacon Lodge, a step-down mental health service in Nottinghamshire. Temi received his award because he has shown great commitment and flexibility. He originally worked in a learning disability service and he has successfully transferred his skills to a mental health service, and helped out another learning disability service when they needed it. His calm, positive approach and skills are valued by his team and a great benefit to the people we support.

Bex

Bex is a Recovery Worker at Somerset Drug and Alcohol Service. Bex received an award because her insight and understanding of others enables her to challenge her colleagues to think in an inspirational way. By encouraging the people we support to aim for change through her positive, inclusive and inspirational approach to recovery, she demonstrates the essence of our values and what we do.

“The most rewarding part of my role is being part of people’s visible recovery. My insight and understanding comes from lived experience and so provides a unique and valuable perspective to both colleagues and service users. As someone in recovery myself the supportive team environment has really enhanced my ability to work confidently with people in groups from all different parts of the community. Previously I had avoided these situations - now group work is one of the best parts of my job.”

Clare

Clare is the Locality Manager at Oxfordshire Learning Disability Supported Living. Clare received her award because she truly integrates our vision and values into the service to benefit the people we support.

This was recognised by the CQC, who commented on her excellent leadership and support for her team. The service was rated as Outstanding - an inspiring example of achievement for others.

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OUR PEOPLE SECTION 02

Training Clinicians Recruitment of specialists with the right level of training and experience is one of the biggest challenges facing the health and social care sector.

The NHS 10-year plan explicitly recognises the scale of this challenge and talks about the need for ‘great leadership’ at all levels if the system is to be able to deliver high-quality care. At Turning Point we use our specialist knowledge and expertise to provide opportunities nationally for health and social care professionals to gain further skills and training.

Training and Support for Primary Care We provide considerable training and support to GPs and other primary care colleagues regarding substance misuse and alcohol at both local and national levels.

Locally we deliver continuing professional development events including webinars, input to vocational training schemes on substance misuse management in primary care, practice prescribing reviews on opiates and other medication that may be misused, and advice to CCGs on protocols around safe prescribing of controlled drugs such as gabapentinoids. Nationally, our clinical leads regularly publish articles in journals such as the Prescriber Journal, present at national conferences - for example, the Royal College of General Practitioners (RCGP) and Substance Misuse Management Good Practice (SMMGP) annual conference - and contribute to national advisory groups such as Public Health England’s Expert Reference Group on Prescribed Medications that May Cause Dependence and the Opiate Substitute Therapy Good Practice Programme Working Group.

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OUR PEOPLE SECTION 02

Wakefield Social worker student Jodie is currently completing a 70-day placement with the community team at Wakefield Hub. She is getting involved with day-to-day activities including patient assessments, recovery co-ordination and working directly with non-opiate clients.

Rochdale & Oldham We currently have two psychology students at Rochdale and Oldham Active Recovery, working across all aspects of a Turning Point service.

Sheffield We offer medical students electives in addiction psychiatry from the University of Sheffield.

Manchester

Leicestershire

Medical students at Manchester University can opt to spend up to two days per week on placement with Turning Point in areas of deprivation.

We offer six month placements for GP Speciality Trainees.

We were the first third sector provider of a training post for addiction psychiatrists.

Counselling students at the University of Leicester are offered placements with Turning Point.

Suffolk

Oxfordshire

Nick is on placement in Suffolk as a CBT therapist in training.

He is in his first year of a two-year course at Buckinghamshire University, where he is providing assessment, formulation and CBT interventions to clients in Ipswich.

We offer 70-day placements to social work students. We alternate the placement between Ruskin College and Oxford Brookes.

We facilitate research, such as the Randomised Injectable Opiate Trial with Professor Sir John Strang and the Institute of Psychiatry, in the Drug and Alcohol Wellbeing and Oxfordshire services.

London We run social health or psychiatry placements for third and fifth year medical students at Imperial College and University College Hospital.

Trainee social worker placements are available with Drug and Alcohol Wellbeing Services.

Somerset We help non-medics, such as pharmacists, to gain non-medical prescriber qualifications.

Naloxone research projects take place with Bath University.

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OUR PEOPLE SECTION 02

Leadership Development & Coaching 2018 marked our commitment to the creation of a new management development programme for managers of managers.

Managers’ Foundation Programme We have also created the Managers’ Foundation Programme, a suite of learning for all first line managers, linked to Skills for Care standards. The programme aims to ensure that all first line managers have the knowledge, skills and competencies required to support high performing teams that meet the needs of individuals we support. It has also been designed so that those identified through talent pipelines as future managers can use the content to develop their skills ready for any roles becoming available. The workshops are delivered business wide so managers can learn from each other, taking experience from across the business to share with their colleagues in a collaborative learning space.

The Inspiring Management Possibility Programme has been designed to provide a holistic, pragmatic and comprehensive view of managing and leading in the Turning Point context. Based on the Skills for Care and NHS Frameworks, it develops knowledge, skills, competence and confidence in leading and managing Self, Team and the organisation. The topics covered include:

This programme has been designed as a blended programme that combines: E-learning linked to regulation and how we do things in Turning Point Workshops that build on the e-learning and reflect on experience and skills needed Competencies

The self-aware leader The accountable and integral leader Why workplace health and wellbeing matters The power of engagement Building financial and business acumen The skills of decision making Leading and engaging change

The programme is aligned to the Inspiring Possibility Programme so that any learning covered in the foundation is a stepped approach, ensuring we stretch leadership learning.

We are continuing to build our coaching support for leaders and develop reflective practice, to develop our managers’ and leaders’ leadership practice, recognising the need to maintain their capacity to think well, individually and together, in an environment of high change and operational demands.

Management Apprenticeships Great leadership starts at different levels of any organisation and we are committed to supporting staff to obtain leadership roles within their relevant fields.

Action Inquiry Groups

We sponsor managers to become apprentices so they can gain the skills needed to become senior managers. Our apprenticeships are provided via Remit, an external provider.

We have launched action inquiry groups as a new form of leadership development designed to create an environment in which individuals can learn from each other, supported by coaching and facilitation and whilst working on common goals. Over time we will learn from these and evolve our approaches to driving more flexible, inclusive and collaborative ways of developing individuals, teams and the wider organisation.

Management apprentices engage in an 18-month programme of further learning to gain a level 5 diploma for leaders and managers.

Managers learn about senior management behaviour, competency and a range of relevant topics.

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OUR PEOPLE SECTION 02

Health and Wellbeing of Employees At Turning Point, our ambitious Health and Wellbeing Strategy aims to create an environment where our people can be their best.

Supporting health and wellbeing is the golden thread which runs through our organisation, be that for the people we support or the people employed by and working with us.

We know that when our people are happy, healthy and engaged, this leads to better and greater client outcomes.

We seek to continue to be a market leader as a provider who can realise the potential of the people who work with and for us, through a comprehensive and evidencebased approach to supporting wider health and wellbeing, alongside our contracted activity.

In 2018/19 Turning Point’s Health and Wellbeing Lead Group came together with representatives from across the organisation as champions for the people they work with and for. With senior representation from the Group Managing Director, the group reviewed the evidence and engaged with staff and service users in order to produce:

Gemma Gemma is a clinical team leader and manager of the mental health service at Pendlebury House in Manchester.

She is enrolled as a management apprentice, due to qualify in early 2020:

A communications plan which sets out our approach to raising awareness around health and wellbeing for our people. It functions through an annual programme of spotlighting and signposting of national campaigns, and sharing of local stories of how our people and clients are managing their health and wellbeing.

Objectives of the plan consist in increasing takeup of Turning Point’s health and wellbeing benefits package including: Rightsteps, our specialist health and wellbeing support; our staff rewards package and access to our Employer Assistance Programme; sharing how employees and the people we support are looking after their own health and wellbeing and the impact it is having.

“The apprenticeship offers me a chance to learn new leadership skills within my current role and to build on the skills I already have.

It has enabled me to learn new theory that can underpin my practice as a good leader for Turning Point, while also offering me a chance to network with other managers within Turning Point.

I hope that once I have finished the apprenticeship I will have the skills and qualifications to move up the career ladder within Turning Point towards a leadership role in the future.”

A range of tools to support managers and staff to have healthy conversations as part of their everyday practice, including health and wellbeing plans, training, audits and appraisal templates.

Registered Managers Forum Our CQC Registered Managers are responsible for managing regulated activities and maintaining regulatory standards on a daily basis on behalf of Turning Point. The quality of our services means everything to us, so we seek to continually improve and innovate.

A business plan for 2019/20 which incorporates a range of key organisational objectives and actions to better support and monitor the impact of health and wellbeing for staff and service users, including the development of an employee wellbeing strategy.

We support our managers to shoulder this responsibility while also supporting their continuous professional development. We provide a peer network called the Registered Managers’ Forum. The forum is a face-to-face meeting between members to discuss regulatory updates, best practice guidance and sharing, and reflection on incidents and learnings from CQC inspections.

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A SHARED APPROACH TO SUPPORT SECTION 03

A SHARED APPROACH TO SUPPORT 22 TURNING POINT ANNUAL REVIEW 2018/2019

A SHARED APPROACH TO SUPPORT SECTION 03

A Shared Approach to Support We are an organisation delivered by people for people, we know there are times when many of us need some extra support. We also know that people need to be involved in all aspects of their own support and treatment.

A shared approach encourages people to take a greater responsibility for their choices, behaviours, health and wellbeing. Supporting people to look after themselves to the best of their ability is a key focus of government policy. The King’s Fund have described this as ‘shared responsibility for health’.

This includes: practitioners working alongside individuals, providing the right training for staff, supporting people to manage their own health, helping people to see their existing strengths as well as connecting them to sources of support within their peer, family and community networks. The long-term plan acknowledges that the NHS will need to work closely with local government and the third sector to make this a reality.

This approach has been a priority at Turning Point during the past year as we continue to develop effective, inclusive and innovative approaches to self-care.

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A SHARED APPROACH TO SUPPORT SECTION 03

My Turning Point At Turning Point, we’re proud to continually refine and develop the support we provide to make sure it fits around people’s needs and their lives.

We have been developing and delivering online support solutions for service users for a number of years, and in 2018/19 we saw a record number of people gaining access to expert online support. My Turning Point provides high quality, evidence based information and support that people can access at a time and place that suits them. More than 2,400 individuals gained access across a range of products, including talking therapies, community-based substance misuse services and crisis mental health services.

in 2018/ 2019

2,424

1,310

people were given access to My Turning Point

accessed My Turning Point via our talking therapies services

149

802

accessed My Turning Point via our crisis mental health services

engaged with My Turning Point via our drug and alcohol treatment services

1,495

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viewed the Find Out More interactive information sessions

A SHARED APPROACH TO SUPPORT SECTION 03

Social Prescribing

Reasons for Referral

Social prescribing offers access to a wide range of health-related services and activities to individuals with social, mental health, physical or other needs. It provides a mechanism for health professionals such as GPs and nurses to refer people to a range of local services which go beyond a clinical need alone. It can also allow people to self-refer for support.

Most of the people we see have multiple concerns, however the most common reasons for referral are:

8%

Physical activity

Broadly, the idea is to empower individuals to make choices that impact positively on their lives by increasing awareness to what support is out there for them and removing barriers to access. It is built on the understanding that many of the things that determine our state of health and wellbeing are due to wider issues that health professionals are not best placed to support, such as social, environmental and financial factors.

34%

Weight management and healthy lifestyle

15%

Total Wellbeing Luton

Loneliness/seeking social support

Turning Point leads on the new Total Wellbeing Luton service, working in partnership with Active Luton, a well-established local provider, to deliver social prescription as one of the many health and wellbeing programmes within the service.

Of the 969 clients we have engaged with in 2018/19, 720 have started a social prescribing plan.

28%

Emotional health

10%

Financial and housing support

3%

Long-term condition or disability

Art Therapy Trevor

When we started in April 2018 there were five GP surgeries engaged in social prescribing. Now, 23 out of the 28 surgeries in Luton offer social prescription.

Trevor, 58, suffered from anxiety about his profession.

He trained in accountancy and economics but felt he should be doing something more creative. He was referred to Total Wellbeing Luton’s social prescription service by his GP, and his link worker referred him to an art group.

This reach makes referrals between GPs and link workers smooth and efficient for many people across Luton who require a range of support. It also enables link workers to update patient records so GPs can see the outcomes of their referrals and the provision of care is connected.

“The jobs I’ve been doing all my life have been regimented and rigid. It went against my personality and pushed me into a downward cycle.

At GP surgeries, our link workers will meet clients at an interval that suits them and from a range of locations, including permanent rooms in practices, out in the community, or over the telephone for people who struggle to meet face-to-face.

I lacked the confidence to go out and do what I really wanted to do.

Social prescription has helped me focus and stop worrying about things that I can’t control.

We now have 60 community providers who have signed up specifically to provide wider support to people accessing the Social Prescription programme, ranging from debt advice and foodbanks to yoga therapy. We are part of the network of community provision which can help people to build sustainable relationships with other people and organisations to help them help themselves in the long term.

I’ve been on the programme for three weeks. I have made very fast progress. I’ve met people who have unusual artistic skills and I’m learning from them to interpret and realise my own ideas.

We’ve done printing using cards and paints. The art is essential — it enables me to express the type of human being that I am and has provided me with an oasis of calm.

I’m able to sleep better because of my reduced anxiety.

My day is more structured so there’s less space to worry about the small things – which I found I was doing before.

Social prescription is giving me confidence to improve other areas of my life, like my diet. It has given me hope.”

25 TURNING POINT ANNUAL REVIEW 2018/2019

A SHARED APPROACH TO SUPPORT SECTION 03

Rightsteps

Family and Friends Support

Rightsteps is part of the Turning Point group and provides employers with access to expert health and wellbeing support for their workforce: www.rightsteps.co.uk.

At Turning Point, we know that the relationships people have with their families, carers and friends can make all the difference between them having the support they need to make positive changes, or not. Considering and supporting people’s social support networks is integral to what we do across all areas of our work.

We are extremely proud of the quality of our services, and in recent years we’ve looked to increase our reach and our income by offering these high quality services to a broader range of customers. Simultaneously, we are developing new ways to deliver support as part of our digital transformation. By blending the expertise of our practitioners, subject matter experts and the skills of our digital team, we’ve been able to offer psychosocial support in new ways: providing health and wellbeing interventions that people can access online or through their smartphones. We offer these interventions as part of our core service provision, but we have also started to make these available to organisations outside of Turning Point – reinvesting the income generated back into the organisation. We have had a really successful first couple of years, having been contracted to provide our Rightsteps Wellbeing service to clients including Electricity North West, Johnson & Johnson and Printed.com. Thousands more people benefit from our support, whilst in turn we can use the generated income to grow our services further.

Family Therapy Last year our Young People and Families Development Manager consulted with friends and family of people using our substance misuse services about implementing a new approach that will be rolled out in 2019 and 2020.

Two programmes which enhance our work with family and friends are being trialled in our substance misuse services: Behavioural Couples’ Therapy is being trialled in Medway, Wakefield, and Leicester, Leicestershire and Rutland to support parents and couples affected by alcohol dependence.

Social Behaviour and Network Therapy (SBNT) is being trialled in our Somerset, IMPACT (Swindon and Wiltshire) and ROAR (Rochdale and Oldham) services.

SBNT is a valuable addition to our programme which brings together up to ten family and friends to support a person experiencing a substance misuse issue.

During 2018/19 Rightsteps provided 13,250 interventions including support and information provided online, face-to-face or via a helpline.

Family friendly approach to weight management Our Total Wellbeing Luton service adopts a family-friendly approach, particularly through supporting children, families and pregnant women to adopt a healthy weight.

Our Healthy Lifestyles and Pregnancy Plus programmes spend dedicated time with parents or carers, expectant mothers as well as their children to individually and collectively explore how to make healthier decisions easier every day. The programmes are designed to be fun and engaging as well as providing information, tools and techniques to eat healthily, move more and achieve a good sense of wellbeing. Healthy adults are the key to role modelling and creating healthy habits in their children.

Besides the successes made through adopting healthier weight, people accessing our programme have reported a whole range of other health benefits, including accessing our talking therapies support for their emotional health, also available within the service.

In 2018 we implemented Rightsteps Wellbeing, an on-demand platform that gives employees instant access to evidence-based health and wellbeing support whenever they want or need it.

Our Find Out More sessions, providing information and advice on a range of health and wellbeing issues, began in June 2018 and have been accessed 5,526 times, enabling people to better understand the issues affecting them or the people in their lives.

“I loved the structure, simplicity and the way it made the participant feel like it was the most normal thing in the world”

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A SHARED APPROACH TO SUPPORT SECTION 03

Rotherham Friends and Family Forum

Some of the comments we received:

In Rotherham we support 35 people with learning disabilities. We established a family forum during the transition across to Turning Point from the previous provider. It is an informal meeting, taking place every 3 months, where family and friends of the people that Turning Point support can meet in a social setting, providing an opportunity for Turning Point to share relevant information such as recent CQC reports, and offering family and friends the opportunity to raise any queries and have an open discussion.

‘’Fantastic support’’

“So very kind and supportive”

“We are involved in decisions”

Gathering feedback from Family and Friends In 2018 we surveyed friends and family of people with a learning disability supported by Turning Point.

We received 143 responses.

97%

said we listen to their views and wishes

99%

“I can sleep at night knowing my son is happy and safe”

71% 87%

said they know who to contact with complaints, comments or queries and they are dealt with in a timely manner

“Staff always find the time to talk to me about my son”

“The manager is very supportive and approachable”

agreed that the support their family member receives is safe and does make a positive difference said they feel their family to their lives member has choice and control over the support they receive

87%

said they would recommend Turning Point to family and friends

27 TURNING POINT ANNUAL REVIEW 2018/2019

“I am consulted in most matters”

“Every time we visit we find staff caring, helpful and doing all they can to improve my son’s quality of life”

INTEGRATED APPROACHES SECTION 04

INTEGRATED APPROACHES 28 TURNING POINT ANNUAL REVIEW 2018/2019

INTEGRATED APPROACHES SECTION 04

Integrated Approaches Integrated approaches and place-based systems are a key theme in government strategy.

The move towards a more interconnected health and social care system in order to provide a more effective and efficient offer to support people with multiple needs will be supported by a ‘duty to collaborate’ on providers and commissioners.

At Turning Point we have long recognised the huge potential of collaboration across different sectors and services in order to reach more people and provide a broader, population health offer for the areas we work in. We look to support the development of more integrated approaches wherever we can.

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INTEGRATED APPROACHES SECTION 04

New models of care

Working across health and social care

In Wakefield, Turning Point is an active member of the New Models of Care Board - a group of senior clinicians, chief executives of local NHS trusts and local third sector organisations.

Beacon Lodge, a 12 bed step down service in Nottingham, opened in September 2016.

The service provides a valuable step in the mental health pathway, where individuals who are leaving hospital following an acute inpatient stay can benefit from recovery-focused transitional support to stabilise their mental health, identify suitable accommodation and access appropriate on-going support.

It gives us the opportunity to have a real say in the local health population needs, including contributing to thinking around health inequalities.

It is hosted by the Clinical Commissioning Group and chaired by a local GP, tackling priorities identified using population health data. These include:

During 2018/19, the service enabled 98 people to achieve positive recovery outcomes and safely transition into the community. Beacon Lodge has resolved housing and social needs, which prevented the person from being discharged; the service has delivered health and adult social care related outcomes, including supporting 38 guests to access employment, education or volunteering opportunities.

Lung cancer End of life integration Mental health Primary care home Elderly care

Seventy per cent of service users have returned to their home, gained new independent accommodation or moved in with friends and family and do not require any other formal support.

Turning Point has been very active in contributing to discussions around new ways of working across Wakefield, the positive impact of our services locally, providing seamless care and reducing barriers between services.

Beacon Lodge is a true example where value is created in one part of the health and social care economy and its benefit is felt elsewhere in the system, but its true value is in the personal support it can give to an individual in a holistic way. Its success is integration not fearful of boundaries or barriers.

“The difference between a hospital setting and Beacon Lodge is second to none. Although my time in hospital was necessary, it was the work that the staff put in at Beacon Lodge that aided my own personal recovery. Workshops on a daily basis, one-to-ones when needed, all delivered with professionalism and a nonjudgemental approach which is crucial in a setting such as this�.

Stephen, former guest at Beacon Lodge

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INTEGRATED APPROACHES SECTION 04

Joint Working across Drug and Alcohol and Mental Health Services

Turning Point’s Inspiring Recovery (substance misuse) and Talking Therapies services in Wakefield joined forces last year to develop a new joint peer mentor course that was open to people who had used either service. In September 2018 the first joint training course was delivered to a total of eight peer mentors. All the peer mentors completed the course and a graduation ceremony was held in December 2018 to celebrate this. The second cohort began in January 2019 with 10 enrolled peer mentors. Having peer mentors who can work across mental health and substance misuse services helps educate the recovery community about the interaction between mental health and substance misuse.

Often people referred to specialist mental health services are asked to address their drug or alcohol use before being offered mental health support - which can be a barrier to access.

Turning Point’s substance misuse and mental health services in Leicester, Leicestershire and Rutland are able to offer mental health support to substance misuse clients, without the need for them to finish treatment first.

The services have developed a reciprocal pathway, which means we are able to offer a seamless service for clients with co-existing mental health and drug and alcohol issues.

In the past 18 months, 190 mental health appointments have been delivered at substance misuse venues across Leicester, Leicestershire and Rutland.

Turning Point has also secured funding to deliver specialist substance misuse and mental health support within a domestic violence service for people with complex needs in Leicester. The HOPE project has a focus on reaching Black, Asian and other Minority Ethnic groups and delivering integrated support across a number of specialist providers.

Turning Point now employs a Counselling Psychologist, Substance Misuse Recovery Worker & Senior Mental Health Recovery Worker within the HOPE project, increasing the reach and scope of both services.

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INTEGRATED APPROACHES SECTION 04

Working in partnership We develop partnerships which enable us to bring together specialist expertise and local knowledge.

SASH, our sexual health service in central London, is delivered by a partnership led by Turning Point and made up of organisations with over 200 years’ collective experience working in health and social care. METRO is a leading equality and diversity charity, providing health, community and youth services across London and the South East, with national and international projects. NAZ is dedicated to delivering culturally-specific sexual health services to those historically left behind, closing the gap in the sexual health outcomes of Black Asian Minority Ethnic (BAME) communities. London Friend is the UK’s oldest Lesbian, Gay, Bisexual and Trans charity. They support the health and mental wellbeing of the LGB&T community in and around London, winning a Queen’s Award for Voluntary Service in 2016. Marie Stopes UK is a charity that has been helping people across the UK to choose if and when they have children for more than 40 years.

Dear Albert is a holistic peer-led, recovery focused organisation established to build sustainable recovery communities for those wishing to move away from problematic alcohol and drug use. We work with them in Somerset, Swindon, Wiltshire, Leicester and Leicestershire, drawing upon their lived experience of successful recovery and sustained change to engage the people we support and family members in mutual aid and peer-led aftercare programmes. Not only do they work with people using the service to co-produce peer-led recovery timetables and initiatives unique to each of the areas where they work, they also upskill our staff to improve their knowledge and understanding of mutual aid and train our peer mentors to deliver their mutual aid facilitation programmes, which results in 84% of people attending mutual aid.

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Bringing together support on healthy lifestyles and mental health

People who contact or are referred to the service will access the services listed below:

Total Wellbeing Luton opened its doors in April 2018 as a trailblazing, one-stop-shop for physical and emotional support. As featured in the 2018 King’s Fund Report on Tackling Multiple Unhealthy Risk Factors, the Local Authority and CCG commissioners in Luton took the bold move with a clear rationale to bring together a range of different services aimed at supporting people who could benefit from adopting healthier lifestyles and accessing support for common mental health disorders. People who experience mental health problems often adopt unhealthy habits.

Similarly unhealthy lifestyles can lead to emotional health needs. Prevention is at the heart of this service to reduce the risk of longer term harm through conditions such as heart disease, stroke and cancer.

Stop smoking

Achieve a healthy weight

Increase physical activity

Manage long-term conditions

Have an NHS health check/ body MOT

Be in control of their emotional health

The service is a working example of how to achieve parity of esteem and has already developed integrated approaches through: Internal support pathways which ensure emotional and physical health is considered A marketing and communications plan which integrates emotional and physical health messages Outreach and event attendance where lifestyle and mental health specialists work together to promote the service Joint programme and workshop delivery, such as therapist input into weight management interventions Recruiting a PhD student in partnership with the University of Bedfordshire to further develop the evidence base for integrated services

Access wider community provision Social Prescription

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INTEGRATED APPROACHES SECTION 05

POPULATION HEALTH AND PREVENTION 34 TURNING POINT ANNUAL REVIEW 2018/2019

INTEGRATED APPROACHES SECTION 05

Population Health and Prevention Turning Point has always considered how we can impact on the health of populations through supporting people and their family, friends and carers with not only the issue they present with, but also with their wider social, environmental and emotional needs.

The spotlight was turned onto population health in 2018 with the publication of the King’s Fund report “Vision for population health” which led to a review of how best we can further our existing work in this area. Population health is an approach which considers a whole population and how direct or indirect action can support preventative action and lasting health and wellbeing changes for many.

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POPULATION HEALTH AND PREVENTION SECTION 05

Leigh’s Story

At Turning Point the concept of “prevention” is about helping people to make informed choices and supporting them to find solutions which can result in them living longer lives in good health. This leads to improved population health and is of benefit to people whom we support, but also for those who we can help to never need our services in the first place. We know this can reduce the burden of current or future ill-health for both individuals we support, their extended networks and demand on health and social care provision. The wider societal value, as described in the NHS 10-year-plan, is also that people are better equipped to thrive in the workplace for longer and also maintain good financial wellbeing.

“When I first contacted Turning Point I was binge drinking 20 units of alcohol once or twice a week.

My drinking occasionally lead to arguments with friends and heavily impacted my bipolar disorder.

I started attending the alcohol and wellbeing group. I hadn’t been to a group before and felt quite nervous. It was less intimidating than I imagined and I immediately felt welcome.

Even though the people there were all from very different walks of life, when it came to alcohol, we were all the same. We all needed to get better.

Our services take a preventative and population health approach through a variety of methods, including:

Being amongst other people with the same problem was really helpful and from the beginning of the course I began reducing my drinking.

Promoting healthy lifestyle choices

The group helped me to cope better with everyday problems and gave me tools that made stopping drinking possible. I started eating more healthily and I lost excess weight.

Reducing drug and alcohol use Developing skills Improving wellbeing

I started generally feeling better and my mental health became more stable, too. I now find it easier to ‘ride out’ periods of depression, without drinking or neglecting myself.

Increasing independence Considering the wider determinants of health Connecting people with wider social and community networks

It has been three months since my last drink, and I am starting to look at going back to work.”

Adopting self-care strategies

Leigh was supported by Turning Point’s drug and alcohol service in Medway

Supporting workplace health initiatives

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POPULATION HEALTH AND PREVENTION SECTION 05

Help people move into work At Turning Point, we recognise the value of work to a person’s health and wellbeing.

During 2018: Although there is evidence that employers’ attitudes towards employing people with mental health problems is improving, much work remains to be done. Employment rates for people with mental health problems are lower than for any other category of disability except for learning disability, according to the TUC analysis of Labour Force Survey, 2017.

We support our clients to access education, training and employment opportunities, enabling people who may have been out of work for a long time to build their skills and experience and have something to show on their CV. We offer a range of volunteering opportunities and paid roles for people with lived experience of a learning disability, mental health or drug and alcohol problems.

We offer student placements and staff and volunteers can access a wide range of training opportunities to boost career prospects.

205

528

80%

people completed the accredited peer mentoring training

peer mentors were in placement

of our crisis and transition mental health services had paid peer worker roles

94

43

£6,000

peer mentors went on to paid employment, of whom 23 are employed by Turning Point

people with learning disabilities were employed to undertake quality checks of our services

in bursaries were awarded to support 13 people to help them take the next steps in life through Ted’s Fund, a fund set up in the memory of a former Chief Executive of Turning Point

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POPULATION HEALTH AND PREVENTION SECTION 05

Joining Forces to Stop Smoking Leicester City Stop Smoking Service began working with Turning Point in 2018 to consider a pilot in the use of e-cigarettes in reducing the harm of smoking specifically targeting alcohol users. Whilst we are aware that a significant proportion of the people we support smoke, the pilot targets alcohol users aged 18 and above only at present. Training was delivered to a number of champions and peer mentors who agreed to take a lead in raising awareness and supporting alcohol and wellbeing groups.

We established a weekly drop-in session that anyone can attend, co-ordinated between a lead recovery worker and peer mentors. Service users are supported to attend six sessions with their recovery worker and peer mentor. They must first complete an assessment around their individual smoking habit and are then issued with a basic e-cigarette and liquid. When the service user has made significant progress, they are issued with an upgraded e-cigarette and their final session focuses on supporting them in moving forwards in their recovery.

The pilot started in March 2019 and will run until September 2019 where a full review will be completed in conjunction with the Stop Smoking Service.

Wakefield Chronic Obstructive Pulmonary Disorder (COPD) pilot Lung disease is often a cause or contributory factor in the death of people with a history of substance misuse.

Living with lung disease can have a major impact on mobility, reducing the ability to work or to engage with the community and increase the challenges of accessing support.

In 2018/19 we delivered a 100-day pilot project in Wakefield, funded by NHS England, targeted at improving engagement with lung disease treatment within the service user group. The pilot, which engaged 89 people, consisted of a simple questionnaire targeted at individuals who smoke or are known to have smoked followed by the offer of screening delivered by the nursing team.

The pilot proved that individuals can be identified before their condition progresses to the level that they access the COPD pathway and that they can be successfully engaged to address their smoking and thereby reduce their risk of developing further issues.

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Reducing Alcohol Related Admissions In Leicester, Leicestershire and Rutland we deliver a hospital liaison service seeing patients that are in the Emergency Decisions Unit (EDU) or on the wards and have substance misuse issues. The Leicester, Leicestershire and Rutland Hospital Liaison team covers three hospitals: Leicester General, Leicester University and Glenfield.

The team takes referrals from EDU and the wards and visits patients to offer harm minimisation and encourage engagement with Turning Point.

In 2018 the team received 1,487 referrals and over a third of these requested further support from Turning Point in the community.

We also support the hospital with substance misuse awareness sessions and last year we delivered this to over 350 professionals.

The team is a useful link between our service users admitted to hospital and our recovery workers in the community enabling support whilst they are in hospital and pre-discharge. The service provides a valuable outreach and continues to grow with referrals increasing every month which has led us to increase the number of hospital workers to three.

39 TURNING POINT ANNUAL REVIEW 2018/2019

HEALTH INEQUALITIES SECTION 06

HEALTH INEQUALITIES 40 TURNING POINT ANNUAL REVIEW 2018/2019

HEALTH INEQUALITIES SECTION 06

Health Inequalities Championed by our Chief Executive, Lord Victor Adebowale, Turning Point has always been acutely aware of how the support we offer to some of the most marginalised people in society can help redress the balance of inequalities which we continue to see across health and care outcomes in England.

Throughout 2018/19 we have continued to explore our role in reducing health inequalities through engaging with staff and external experts, including Professor Sir Michael Marmot at the Institute for Equity at UCL and Coventry Council as a leading “Marmot city”, which has already seen a marked difference at population level as a result of their work.

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HEALTH INEQUALITIES SECTION 06

Integrated Street Engagement Unit

As differences in life expectancy between different groups in society continue to exist, and in some cases get worse, Turning Point’s role to play is clear in giving the people we work with the best chance to avoid future ill-health and consider how broader aspects of their life can support that, including housing, social connectedness, education, employment, healthy lifestyles.

Peter is an integrated street outreach worker for Turning Point. He has been working with the homeless to provide substance misuse support around the Westminster area over five years. He says the Integrated Street Engagement Unit (ISEU) project is a positive new approach:

The NHS 10-year plan includes specific goals for particular groups, such as an increase in physical health checks for people with severe mental health and additional investment in healthcare for rough sleepers, including better access to specialist mental health support. This is something that has been a focus at Turning Point throughout 2018/19.

“The ISEU is a frontline partnership working in central London. It includes staff from Turning Point, Westminster City Council, the Metropolitan Police, The Connection day centre at St Martins-in-the-Fields, The Passage (a resource centre for homeless and vulnerable people), and street outreach teams such as St Mungo’s and The Compass.

The project combines integrated health, housing and social care support to provide effective routes off the street.

We recognise that enforcement isn’t the most effective way to support people who are sleeping rough, and that in the long term we need to address the wider needs of every individual. In every operation, there are two plainclothed police officers, a city inspector, myself and other partners, depending on the nature of the operation. On larger operations we can have teams of up to 15 people.

When we approach an individual of interest, I often lead in approaching and engaging the individual into conversation.

Nine times out of ten, people are willing to have a chat and are receptive. In some cases we’re faced with challenging clients who will refuse support, and this is usually to do with trust.

Last year I engaged with 104 clients, with heroin, cocaine and spice being the most commonly used drugs.”

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HEALTH INEQUALITIES SECTION 06

People accessing Total Wellbeing Luton

40%

35%

30%

25%

20%

15% 10%

5%

0%

1 (Most Deprived)

2

3

4

5 (Least Deprived)

Total Wellbeing Luton In addition to providing population-level support for people of Luton who seek to adopt a greater sense of physical and emotional wellbeing, our Total Wellbeing service also carry out targeted work with groups more likely to experience health inequality.

you are likely to live in good health. In Luton we work with people in the most deprived areas where challenges extend beyond health to low rates of employment, income and greater barriers to accessing support. Over a third of people who access our service in Luton come from the 20% most deprived areas in the country. 67% of people accessing our service come from the 40% most deprived areas in the country.

It is widely evidenced that where we live and the amount of money we have can directly impact on both the length and quality of our lives. The wealthier you are the longer

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Healthcare for homeless people Camden Health Improvement Practice (CHIP) is an NHS service run by Turning Point which provides health services to homeless people. As a drop-in health practice, CHIP welcomes anyone without any need for ID. Paul, the practice manager, says: “Patients tend to be very complex. Some of them don’t present very often, so they’ve stored up a whole set of issues.”

An important routine for each new arrival is the comprehensive health check, lasting around 45 minutes, which includes tests for HIV and hepatitis B and C. This is seen as an important opportunity to engage.

“A lot of these patients don’t go to a GP at all – they let themselves get so ill they go straight to hospital and it’s an endless cycle. So at least if they’re coming in here and getting their primary care managed, they have a better chance of stopping that from happening.”

CHIP is part of a network of specialist support including hostels, drop-ins and day centres, so there are places to refer young people, sex workers, and people arriving from other countries who might need all kinds of help.

A doctor from CHIP goes out on his bike twice a week to visit the hostels and reach out to people who won’t come to the centre.

The team’s weekly meetings are a focal point for agreeing the way forward for each patient, bringing in the other services as needed, or attending multi-disciplinary meetings outside. Complex patients might need expertise from mental health, drug services, social services, police and safeguarding. Hepatology and HIV consultants visit the service every two weeks and there is support available for mental health problems and personality disorders. The Citizens Advice Bureau worker comes in once a week to help with benefits and housing.

“A lot of the time we find you have to do everything while the patient is right there in front of you,” says Paul. “The minute they go out the door, there is a risk you’ll lose them again. You want them to come back, and if you take a rigid approach to it they won’t come back at all. Then we can work on their other issues – it’s a different concept of medicine to a mainstream practice.”

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Black, Asian and Ethnic Minority Groups There is evidence that people from Black, Asian and Ethnic Minority (BAME) groups have poorer access to health and social care services, and experience poorer outcomes. At Turning Point we work closely with local voluntary and community organisations and groups, building strong partnerships and making sure our services are accessible to all sections of the community.

Our sexual health service, SASH, is delivered as a consortium, with Turning Point as the lead provider.

In order to address the inequalities in access to sexual health services we partnered with NAZ, who deliver culturally-specific services to BAME communities across London.

A service user and service manager were interviewed on BBC Radio Leicester about their personal experiences around problem drinking within the Punjabi community.

They also discussed how Turning Point is working with different local partners to engage people with the service.

Our staff speak many languages. SASH, our sexual health service, provides coaching and counselling services in English, Spanish, Polish, Portuguese and French.

Our IMPACT drug and alcohol service in Wiltshire and Swindon gave a presentation to the trustees of Trowbridge Mosque, including a member of the National Muslim Council.

A BAME peer mentoring programme has been established at SASH. As part of this, BAME women are able to offer each other support with their sexual and reproductive health needs.

If someone’s language isn’t represented in the materials of the service they would like to access, we are able to provide a bespoke translation.

At the Luton Total Wellbeing service we developed a Ramadan-related healthy lifestyle programmes for Muslim women – co-produced with women from a local mosque where the programmes were also delivered to increase ease of access and engagement.

Our Leicestershire service has partnered with Leicester University to provide talks to Islamic student groups.

45 TURNING POINT ANNUAL REVIEW 2018/2019

MENTAL HEALTH SECTION 07

MENTAL HEALTH 46 TURNING POINT ANNUAL REVIEW 2018/2019

MENTAL HEALTH SECTION 07

Mental Health Mental health is a key priority for Turning Point and the government.

As a provider of mental health services, we know that support is not only required at points when people are struggling themselves, but also to create good mental health and wellbeing which can be nurtured and maintained.

Turning Point services are developed on the principles of the 5 ways to wellbeing, embedding approaches to keep people well. Our organisational expertise is also able to make sure that problems are identified and supported appropriately when they arise.

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MENTAL HEALTH SECTION 07

Crisis Services In the coming years, the government aims to create a more comprehensive mental health system, particularly for those seeking help in crisis.

Haven House, Nottinghamshire

Crisis services are a key part of Turning Point’s mental health offering. Across our four crisis services in 2018/19: 1,115 guests have stayed in crisis houses 413 people have taken part in crisis café or drop-in sessions 6,009 people have spoken to helpline workers at Leicester Crisis House We were involved in the suicide prevention campaign ‘Start a Conversation’ in Leicestershire Our Nottingham Crisis House held reiki training for staff and people we support Three crisis houses now offer My Turning Point digital support Our crisis houses have increased awareness and staff training on supporting autistic guests

Feedback from Guests At Turning Point we really value feedback from our guests, listening to what people have to say about their experiences and implementing necessary changes to ensure we are doing the very best job we can do across all the different services we offer.

Did you feel supported by the staff at the Haven House service?

151 YES

NO

Do you feel better equipped to manage a crisis in the future?

128

17

Did the Haven House team offer you choice and control about what support you would like?

150 YES

0

NO

Has the service supported you to find appropriate information about local services, resources and activities?

139

11

Has having the opportunity to talk to someone improved your wellbeing?

143

6

YES

YES

YES

2

NO

NO

NO

[Benefits of Support Questionnaire Results Apr18-Mar19]

“When I came to Crisis Point I had never felt lower, but over the ten days I laughed and made friends. The staff are amazing and are always available for chats even if you have had your session. Thank you everyone at Crisis Point, you made me feel cared for.”

“I am astounded at the change in myself during my stay here. The staff are amazing and, most importantly, approachable. I came in here scared and mentally trapped and I’m leaving hopeful and excited for the

future and it’s all thanks to Crisis Point. Life-savers!”

“The staff were extremely helpful during my stay. Every one-to-one session I had was really beneficial and I’ve learned new coping mechanisms. The environment is so peaceful and accepting. Very thankful to Crisis Point for all their help! I can’t compliment the service enough.”

“The staff have shown kindness and empathy during my stay. They have made sure I don’t isolate myself.”

Crisis Point, Manchester

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Leicestershire Crisis Service

Talking Therapies

Last year the Leicestershire Partnership Trust asked clients at our Crisis services if they would recommend the service to their friends and family if they required the same or similar care.

Turning Point Talking Therapies services are designed to provide quick and easy access to a range of psychological therapies. The service provides National Institute of Health and Clinical Excellence approved support faceto-face, over the phone or with online support through My Turning Point, our digital therapy tool. We provide workshops and groups on a wide range of issues including improving sleep, emotional eating, body image, managing panic attacks, improving low mood, relaxation, supporting loved ones, assertiveness and mindfulness.

The answer was a resounding yes with 96% of guests from the past 11 months saying they would be “likely” or “extremely likely” to recommend Turning Point Crisis services to loved ones.

“They are the best staff I’ve ever had the pleasure to meet. I honestly cannot say one bad thing about anyone, also the group of people in the house. It’s been a pleasure to be here.”

Peer Mentors at Wakefield’s Turning Point Talking Therapies service are volunteers who have previously used the service themselves. They are a visible presence in our waiting rooms, groups and workshops as well as at local events. The team is responsible for developing a programme of activities for people waiting to start their formal treatment and to also provide a point of contact for those who have completed treatment and would like to meet like-minded people.

“You have saved my life and given me the tools to move forward and be happy.”

Supporting people to self-manage in a crisis The Leicester, Leicestershire and Rutland Crisis House service was first approached by the Leicestershire Partnership Trust Recovery College to see if we would be interested in creating and running a course looking at risk, safety and mental health back at the beginning of 2018.

It started as an idea from one of the Recovery College’s peer tutors, and consisted in creating a course that would enable and empower learners to explore ways of managing their mental health and risk when in crisis. The first time the course ran in late 2018 it was received very positively from both students and staff.

As each team member develops, they provide one-to-one support for individuals awaiting treatment in order to help point them towards appropriate services and to show them the realities of recovery.

In 2018/19 our talking therapies services supported

Feedback from an observation of the course was very positive with many strengths identified including an inclusive, empathic, understanding, encouraging, and engaging approach to learning and students. The feedback recognised that the course covered a “sensitive area with the potential to cause some emotional reactions in the room, however it felt focused on hope, the future and selfmanagement in a very positive way”. We are very proud to have created such an innovative course, as we have been told that there is nothing else like it at any other recovery colleges. The course will continue to run during 2019/20.

17,926 people

“Carol’s energy and enthusiasm shone brightly as soon as she walked through the door. Her ability to comfort and support our mental health service users within an instant of meeting them is a skill and true asset to Turning Point Talking Therapies” — Kayleigh, Clinical Support Worker at Turning Point Talking Therapies after witnessing Carol volunteering in our waiting rooms.

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SUBSTANCE MISUSE AND PUBLIC HEALTH SECTION 08

SUBSTANCE MISUSE AND PUBLIC HEALTH 50 TURNING POINT ANNUAL REVIEW 2018/2019

SUBSTANCE MISUSE AND PUBLIC HEALTH SECTION 08

Substance Misuse and Public Health Turning Point plays a key role in tackling drug and alcohol problems by providing high quality services.

The Care Quality Commission (CQC) did not rate independent standalone substance misuse services until July 2018.

Our registered services were inspected prior to this time and were subject to the same regulations as other services but were not given a rating. Following consultation with the sector, this change was made and a new round of inspections commenced last year to provide ratings.

In 2018/19 75% of all standalone substance misuse services rated as Outstanding were delivered by Turning Point. Nationally, only 2-4% of health and social care services receive an Outstanding rating — so we are very proud of this achievement.

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SUBSTANCE MISUSE AND PUBLIC HEALTH SECTION 08

CQC Results OUTSTANDING: Leicester, Leicestershire and Rutland

Inspiring Recovery Turning Point’s Wakefield Inspiring Recovery substance misuse peer mentors co-facilitate groups and support with events, activities and outings for people who have completed treatment as part of the aftercare programme. These include art groups, mindfulness and visits to Yorkshire Sculpture Park.

“The senior management team had developed and supported team leaders and staff to embed a culture of shared values based on inclusion, partnership working, learning and innovation.

Governance was exemplary. The provider had a range of governance and assurance processes that provided structure and maintained high standards of quality for the service and clients.

Peer mentors have also attended the annual Recovery Walk and a recovery art exhibition, both in September 2018. Other events include networking with external organisations, including day visits to Northern College to encourage people to enrol for further education courses.

The provider recognised that continuing development of staff skills, competence and knowledge was integral to ensuring high quality care.”

Peer mentors are also working towards offering oneto-one support for clients and are developing a service user newsletter.

OUTSTANDING: Oxfordshire

“Pat was really helpful and enriched the group with his own personal details which the clients could relate to. He was a real asset” — said Claire, a Criminal Justice Worker after Peer Mentor Pat co-facilitated the Alcohol & Wellbeing Group.

“The service showed a real commitment to interagency team work which had led to successful innovations to meet the needs of offenders, homeless clients, clients with a dual diagnosis and people requiring treatment for hepatitis C. Clients described the service as offering more than just treatment; it also offered activities that helped them with their overall wellbeing.

The leadership, governance and culture of the service were used to drive and improve the delivery of high-quality person-centred care.”

OUTSTANDING: IMPACT Swindon and Wiltshire “A strong recovery ethos ran throughout service delivery and all staff shared a clear definition of recovery. Staff were hard-working, caring and committed to delivering a good quality service.

They spoke with overwhelming passion about their work and were proud to work for Turning Point.

Staff supported clients to engage in their local community.

Dedicated workers facilitated clients’ engagement with community services and worked to bridge the gap in support after treatment and promote independence and self-care in clients.

People’s individual needs and preferences were central to the planning and delivery of tailored services.”

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SUBSTANCE MISUSE AND PUBLIC HEALTH SECTION 08

Innovation, Inclusion and Involvement The Drug and Alcohol Wellbeing Service (DAWS) covers the City of Westminster, the London Borough of Hammersmith and Fulham and the Royal Borough of Kensington and Chelsea.

The DAWS Innovation Fund supported the development of 21 projects in 2018 including:

SASH

A Healthy Minds Networking Event which enabled 34 partner organisations to come together and promote their services, offer taster sessions and engage with local people.

SASH is Turning Point’s sexual health service covering the London Borough of Hammersmith and Fulham, the Royal Borough of Kensington and Chelsea and the City of Westminster. We believe that people of all genders and sexuality deserve good sexual health. The service provides free sexual health services, delivering non-judgmental, confidential support to improve sexual health, relationships, and mental health.

A series of winter trips run by Hammersmith Community Gardens Association targeting people who are socially isolated. Trips include a walk and visits to The Wetlands Centre, Kew Gardens, The Wellcome Collection, Hammersmith riverside, Kensington Palace Gardens, The Garden Museum and Osterley Park.

In 2018/19, 2,287 adults were supported by SASH.

HIV Arts Project

A community garden space at Chelsea Physic Garden and a pilot programme of gardening and horticultural therapy for people in recovery, Help Us Grow, for one afternoon a week for eight weeks.

In 2018, SASH enlisted the help of artist Charlotte Newson to produce an art exhibition designed to coincide with Sexual Health Awareness Week.

At the beginning of 2018, two clients discovered a mutual love for fishing. Thanks to a grant from the Innovation Fund, they organised, advertised and went on a series of fishing trips, promoting social inclusion and peer support among people who are recovering from homelessness as well as overcoming challenges such as alcohol and drug misuse.

The exhibition focused on stigma around people living with HIV and SASH clients met and participated in weekly workshops for six months to discuss ideas and produce art.

The project highlighted the fact that HIV isn’t always doom and gloom. It’s about growth and beauty, too. The work included visual art, textures, audio, smells and text.

Their hard work culminated in two exhibitions across the City of Westminster and the Royal Borough of Kensington and Chelsea in London:

A history project for older people who have experienced homelessness which involved a programme of trips to sites of historical interest, planned and organised by the group themselves. Highlights included a tour of Central St Martin’s School, a “take-over” session in the archive studio and involvement in the careful restoration of old theatre programmes.

POSITIVE was a sensory, interactive exhibition telling real-life extraordinary stories of living with HIV. Telling stories of HIV was a garden created by people living with HIV. Last December, SASH also marked World AIDS Day with a free public film screening of the documentary ‘Nothing Without Us: The Women Who Will End AIDS’. The film, directed by Harriet Hirshorns, tells the story of the inspiring women at the forefront of the global AIDS movement.

It combines archival footage and interviews with female activists, scientists and scholars in the US and Africa.

“I loved getting my hands dirty, planting seeds, watching things grow from nothing… I never missed a class and always knew if I came I would leave happy. There is something magical about the garden that raises my spirits.”

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LEARNING DISABILITY SECTION 09

LEARNING DISABILITY 54 TURNING POINT ANNUAL REVIEW 2018/2019

LEARNING DISABILITY SECTION 09

Learning Disability For the first time in 2018/19, improving care for people with learning disabilities and autism was recognised as a national priority in the NHS long-term plan.

Commitments include increasing access to support for children and young people with an autism diagnosis, developing new models of care to provide care closer to home and investing in intensive, crisis and forensic community support. The aim is that inpatient provision will have reduced to less than half of the 2015 level by 2023/24.

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LEARNING DISABILITY SECTION 09

Transforming Care At Turning Point, we have been prominent exponents of the Transforming Care programme.

Home At Last Andrew

After thirty years in various secure hospitals, Andrew moved into his own home with Turning Point’s support last year. Here he talks about his experiences of violence from staff and other patients as an inpatient, the negative impact this had on his mental health and the positives about becoming more independent: “It was strange in hospital. People weren’t nice to me. I couldn’t bring in the food that I wanted.

One of the staff beat me up and put me in seclusion.

I was that bruised. I sued them and when I moved to a different hospital, one of the staff took the mickey out of me.

One of the patients battered me, I was bruised and beaten up four times.

Over the past year we have used our expertise to support and empower more young people and adults to seek and achieve a better quality of life and to boost aspirations for their futures.

I was not happy and the staff didn’t do much about it. They said I wasn’t reasonable. It made me feel stressed and nervous and down.

I pushed and pushed and pushed to get out of hospital because it was driving me mental. Every ward round meeting I asked ‘when can I leave?’

It is our profound belief that people with learning disabilities, autism and mental health challenges can thrive in a home of their own. Our personalised approach responds to each individual’s unique requirements and reshapes the health, social care and social network support around them. We work in partnership with individuals and their families to build foundations for future achievements.

The staff at Turning Point supported me and looked after me and I was treated with respect. They helped me through the transition to becoming independent.

I helped choose my house. It’s a nice house. I’ve got a TV, ointments, I’ve got everything. I’ve got two sheds.

At Turning Point we understand the risks and challenges arising from developing and delivering life-changing support strategies. It is not always a linear journey and this shows up in different ways for different people.

I make things. I’m good at sanding things. I’m good at cooking. I do bacon sarnies. I help clean up.

Over the past year we have faced challenges but at all times we remained focused and committed to supporting the individual, evaluating obstacles, seeking out necessary resources, sharing ideas and information and gaining perspective of what needs to be done. We understand that to be successful we must continuously learn and continually look for ways to improve.

I’ve got arthritis so I have to take it slowly. I play games on my laptop. I like my games, it keeps me occupied.

I’ve got neighbours who talk to me. I go to them or they come to me. I offer them tea or coffee.

I’m a lot happier now I am in my own house. I can go out whenever I like. I have a peaceful life.”

We have seen how people’s lives have been transformed through living in their own homes and we’re proud to have played a part in that process.

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LEARNING DISABILITY SECTION 09

Moving On We are committed to transforming the care system and effecting change for those with the most complex needs and challenging behaviours. An example of this is the experience of two people we support in Kent. In 2014 we took over the running of a private hospital with the view that transformation was essential. Placed under the Mental Health Act, both individuals had rarely left the unit and were often restrained either by seclusion, medication or physical restraint. Our goal was to enable the two individuals to move into their own homes, as valued citizens.

Sailing Success Paul supports Michael, who sails at Royal Yachting Association Blackwell Sailing Club. Michael has a diagnosis of Autism and severe learning disability.

Turning Point provides round-the-clock support for Michael in all areas of his life.

The first move was to remove all forms of restraint by embedding the right culture, skills and training, not just in our team, but also in their network of clinicians and stakeholders. We built a shared understanding and intrinsic respect for their needs, choices, ambitions; addressing these by enabling co-produced individualised dynamic risk and support plans. Where they lived was transformed from an institutional, stark clinical space to a homely place where psychologically informed support was not just possible, but quite natural in the flow of everyday life. The focus shifted to getting out and about and included re-establishing relationships with parents and other family members.

Michael

“I sail at the RYA Blackwell Sailing club, on Lake Windermere, and I knew they needed a volunteer.

I thought Michael would be perfect as he and I have often gone sailing together and he and his parents enjoy an evening out on the lake steamer, The Swan.

It’s great when activities that staff are involved in can become an opportunity for really positive support for the people we support.

Michael volunteers at the club with my support.

He has an RYA sailing skills log and is learning knots.

Finding the right new home for them was a necessarily lengthy task which ensured they had time to choose where they would live and that it would be perfect for them. They now live in their own homes free from Mental Health Act (MHA) section and restraints, free to engage in and personally undertake daily activities, independently for themselves, wherever possible. They are developing a positive presence in the community and accessing community resources as they wish. Why are we proud of this and how do we know it is successful? Both confidently focus on what is possible and what their future life can be. They are supported by values-driven staff who want to help them make their ambitions a reality. It is profound, life-affirming change, genuinely inspired by possibility.

The night before, Michael and I pack a kit bag with dry gear and make a packed lunch. We drive to Windermere in the morning.

We have a team briefing in the clubhouse with other sailing instructors and support workers. We assess weather and conditions and decide if we’re having our picnic on the boat or back at the clubhouse.

Michael then gets changed into waterproofs and a lifejacket. We encourage him to support others getting the access boats into the water. Access boats are designed for additional needs sailors.

He’s an enthusiastic rower and enjoys a good sea shanty.

It’s a sure sign he’s having fun.”

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LEARNING DISABILITY SECTION 09

People’s Parliament The regional People’s Parliaments aim to maximise the involvement of people with learning disabilities across their support.

Following a vote on the day, the Milton Keynes People’s Parliament, who showcased a number of individuals’ inspiring life transformations and integration into their community, picked up the title of National People’s Parliament Winner in 2018.

At the 2018 People’s Parliament, quality checkers talked about their role. The team includes people with lived experience of barriers faced by disabled people (quality reviewers) and Turning Point staff (quality partners), and are trained to carry out reviews on individuals, measuring the evidence against the Quality of Life Standards.

They have been set up to ensure that all individuals supported by Turning Point are empowered to influence what the organisation does at a local and national level, as well as taking a more active role in their communities.

The regional forums are a safe place where people can build confidence, talk about what is important to them and share their views in a way that is meaningful to them.

Kent has had an established People’s Parliament forum for several years, named ‘Monthly Matters’. This particular forum has focused on developing their very own community ‘what’s on’ guide and organising monthly trips out for anyone who wishes to join them. More recently, a second and more formal People’s Parliament forum (Monthly Matters 2) has been introduced, which aims to provide a platform for people to share their good ideas and concerns about their community and their support. At their recent Monthly Matters 2 meeting, Nivin and Louise talked about barriers they face on public transport and discussed the possibility of speaking to a representative from the local bus company.

Brian

Quality Reviewer I try my best I am passionate about people I have an infectious smile

The national People’s Parliament is an annual event which brings together representatives from each regional parliament, Turning Point staff from all departments and levels of the organisation including our chief executive.

The aim of the day is to share what they have been working on throughout the year and express their views to the Operating Board and non-executive board members.

The national People’s Parliament 2018 was attended by 110 delegates and focused on citizenship. All of the regions shared the work they had done to contribute to their immediate and wider communities throughout the year and celebrated their achievements.

Lou

Quality Reviewer I am driven and motivated I have empathy for other people I can talk the hind legs off a donkey

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LEARNING DISABILITY SECTION 09

Measuring Outcomes During 2018/19, teams working in Tameside, Barnsley, Rotherham, Derbyshire, Staffordshire and Milton Keynes started using the Life Star™ as part of the support they provide to individuals with learning disabilities.

What is the Life Star™?

The Life Star™ is a holistic and empowering support planning tool designed to provide consistent outcome measurements and a structure to key working which supports people to think about the different things that affect their life, health, wellbeing and daily living.

For support teams:

The tool enables teams to work with the person they are supporting to look at the relationship the person has with the different areas of their life – how motivated and supported they are in moving forward and in sustaining a better situation. Each outcome area is broken down into smaller steps, providing a way of consistently and objectively measuring distance travelled.

Completed Life Star™ programmes give a clear picture of a person’s assets and needs and identifies where they are on their journey. This enables breaking change down into manageable steps so that support is better targeted.

Collated Life Star™ data provides information on outcomes to pinpoint good practice. It will also help identify gaps in provision or areas for improvement.

As support teams share knowledge and learning from the Life Star™ they can refine their practice to make a real difference to the outcomes for the people they are supporting.

What are the benefits of using the Life Star™?

For the organisation:

For people we support:

Each Life Star™ gives clear evidence of the impact a service is making across several outcomes and can help to bring a focus on outcomes to the commissioning process.

People like the Life Star™ because it is simple to use, highly visual, person-centred and strength-based.

The tool’s collaborative nature means that people are engaged in their own process of change rather than being something ‘done to them’.

The visual aspect of the Life Star™ is easy to understand, the language is clear and simple. It structures key work and helps to break down actions into realistic achievable steps.

The Life Star™ can support any person to make sustainable changes to their life even if they need high levels of staff support in many areas, as it focuses on individual strengths and motivation.

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FINANCIAL PERFORMANCE SECTION 10

FINANCIAL PERFORMANCE 60 TURNING POINT ANNUAL REVIEW 2018/2019

FINANCIAL PERFORMANCE SECTION 10

Financial Performance Turning Point has had a good performance this year, achieving a turnover of £131m and generating an operating surplus which has been reinvested back into the organisation and our services.

The key drivers of our improved performance are a key focus on driving greater systemic efficiency and continued innovation, particularly in blending digital solutions with face-to-face support, enabling us to deliver services in new ways with the added value of increasing accessibility and flexibility to the people we support.

more effectively. We have been awarded new contracts in all our business areas and this has generated additional income of £10m. Our new services are Rochdale & Oldham Active Recovery, Wiltshire & Swindon IMPACT, Total Wellbeing Luton, and learning disabilities support in Rotherham and Northumberland.

Our operations have seen quality maintained to a high standard with all our substance misuse services achieving ‘good’ or ‘outstanding’, and 94% of all our services being rated ‘good’ or ‘outstanding’ by the CQC. The health and social care sector continues to operate in a challenging environment with reductions in funding from commissioners, increases in National Living Wage and increases in pension contributions. Turning Point has met these challenges by continuing to invest in our people, processes and technology so that we are engaging with the people we support even

The performance in the year has built on the financial planning in recent years. The operating surplus has been reinvested in the business to finance future growth and success for all of our stakeholders.

The Board has approved the budget for 2019/20 which recognises that we continue to operate in a high-risk and volatile environment. We have a clear strategy for retaining existing contracts and winning new contracts, ensuring we improve our financial position through further transformation of services and efficiencies in delivery.

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RESERVES SECTION 11

RESERVES 62 TURNING POINT ANNUAL REVIEW 2018/2019

RESERVES SECTION 11

Reserves The Board assesses the risks to the organisation annually, and sets the target level of unrestricted funds. In the short term, the Trustees have set the target for unrestricted reserves to cover the pension reserve, thereby bringing total reserves back to a positive position. Thereafter the target is one twelfth (8.33%) of income, which is £10.9m based on the income from operations in 2018/19.

Reserves are that part of a charity’s unrestricted income funds that are freely available to spend to further the charity’s objects, and have been set aside for future use.

Turning Point has no designated or restricted funds.

This year we have transferred operating surpluses of £3.2m to reserves as a result of a good performance.

Our contribution margin has exceeded targets in all business units, as we are now seeing the benefits of our focus on driving greater systemic efficiencies and investing in our people, processes and technology to enable us to develop more effective ways to run the business and deliver services. We remain in active dialogue with commissioners to ensure funding is adequate to meet the contract requirements and the needs of the populations that we serve. We are introducing advanced management information tools to enable us to more effectively collate and analyse data from all business applications and this will allow us to identify further efficiencies that will drive cost savings in 2019/20.

The Operating Board is actively engaged in building reserves in line with this target, through growth, realising efficiencies and leveraging our investment in people, processes and technology. The organisation continues to win new business and is proactively developing innovative new services and service models that meet the changing needs of the people we support and the requirements of commissioners.

The Board has reviewed the budgets and cashflow forecasts for 2019/20, which reflect all of the known opportunities and challenges, both internally and in the external environment. They consider the cash balance to be adequate for the purpose of meeting the working capital requirements for the foreseeable future and coping with the financial impacts of the risks faced by the organisation. The approach to reserves is approved with input from the Audit Committee.

FRS 102 requires the discounted value of the Group’s future contributions to the defined benefit pension scheme (£13.2m at 31/03/2019) to be provided for on the Group’s balance sheet. This is an accounting adjustment and does not directly impact our operating cashflows. This gives a total reserves position of -£9.6m when including the pension reserve. Free reserves consist of unrestricted reserves minus fixed assets. As at 31 March 2019, the free reserves were -£1.1m (2018: -£4.3m).

63 TURNING POINT ANNUAL REVIEW 2018/2019

CORPORATE STRATEGY SECTION 12

CORPORATE STRATEGY 64 TURNING POINT ANNUAL REVIEW 2018/2019

CORPORATE STRATEGY SECTION 12

Corporate Strategy Our strategic period runs from April 2017 through to March 2022 and builds upon the successes delivered over the previous strategic period.

The current strategy will see Turning Point forge a new era of health and social care delivery drawing upon 55 years of experience while extending our reach and effectiveness through the opportunities presented by technology.

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CORPORATE STRATEGY SECTION 12

66 TURNING POINT ANNUAL REVIEW 2018/2019

CORPORATE STRATEGY SECTION 12

Our corporate goals People

Growth

To recruit, retain and develop high performing individuals and teams who are driven by our values, passionate about delivering innovative, high quality services and who inspire possibility in each other and in the people we support.

To realise our vision through responsible growth and by retaining and increasing our market share for our existing products.

Quality

Innovation

To ensure that we deliver on our promises to our clients, customers and the people we support, meeting or exceeding their expectations in terms of both quality and cost.

To innovate in the way we operate, finding new ways of supporting people and embracing digital technology.

Diversification & Integration

Financially Secure

To extend our reach into services which improve health and wellbeing in the population. Working closely together as one Turning Point, sharing our knowledge and expertise, we will provide integrated services to the people who need them to simplify and improve their support.

To ensure that we are financially secure for the future and that we can continue to reinvest in our services, in innovation and improvement and in our people.

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CONTACT US Head Office Standon House 21 Mansell Street London E1 8AA Tel: 020 7481 7600 Email: info@turning-point.co.uk